Provider Demographics
NPI:1104517143
Name:CERBONE, CHASE JAMES (DMD)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:JAMES
Last Name:CERBONE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 ROOKERY PL
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8368
Mailing Address - Country:US
Mailing Address - Phone:561-319-7209
Mailing Address - Fax:
Practice Address - Street 1:155 SW PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5039
Practice Address - Country:US
Practice Address - Phone:772-621-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist